What are the Problems Associated with Compression Stockings?
The contraindications of graduated compression stockings are listed in Box 3.6–9 The stockings are generally safe to use, with relatively few complications. Poorly fitting stockings can cause discomfort and, at worst, pressure necrosis. The use of graduated compression stockings on legs with impaired arterial flow can worsen ischemia.6,7 Patients who are allergic to the stocking material may develop contact dermatitis, skin discoloration and blistering. For example, in CLOTS (Clots in Legs or Stockings after Stroke) trial 1 — a multicentre randomized controlled trial (RCT) that assessed the effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke in about 2500 patients — skin breaks, ulcers, blisters and necrosis were significantly more common among patients wearing the stockings than among those not wearing them (5.1% v. 1.3%).8 Textile properties, including fabric roughness, thermoregulation and dye, may contribute to skin reactions.
Contraindications to graduated compression stockings
· Suspected or proven peripheral arterial disease, including history of peripheral arterial bypass grafting
· Severe peripheral neuropathy or other cause of sensory impairment
· Allergy to stocking material
· Massive leg edema or pulmonary edema from congestive cardiac failure
· Local skin or soft-tissue condition, including recent skin graft, fragile “tissue paper” skin, gangrene, oozing dermatitis and severe cellulitis
· Extreme deformity of the leg, or unusual leg shape or size preventing correct fit
Many complications of graduated compression stockings are preventable if patients are assessed, measured and fitted appropriately. If complications occur, many are easily overcome by refitting the stockings, changing the material, applying an emollient and reducing the degree of compression. Accurate measurement of the limb diameter that conforms to the stocking manufacturer’s guidelines should be performed by a trained health care professional, often a nurse.
Noncompliance
The noncompliance rate for graduated compression stockings has been reported to be 30%–65%.10,11 Commonly cited reasons include pain, discomfort, difficulty donning the stockings, perceived ineffectiveness, excessive heat, skin irritation, cost and appearance.6,10,12 Clinicians should ask their patients why the stockings are not being used, because many of these factors are easily amenable by simply changing the stocking material, lowering the degree of compression or providing adequate information and reassurance to patients. Box 4 shows the information that we believe should be given to patients when prescribing graduated compression stockings.